IRDES Newsletter

Study Days « Cooperation and participation in health workshops »

The French Sociology Association (AFS), the members of the boards of the thematic networks "Knowledge, work and professions" (RT 1) and "Health, medicine, illness and disability" (RT 19), in partnership with nine research institutions including IRDES, are organising two inter-network study days on 28 and 29 March 2019 at Paris-Nanterre University, France. They will explore the forms of collaborative work in health care and their potential effects in terms of task sharing, redefinition of professional boundaries and reconfiguration of professional territories.

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5th IRDES-DAUPHINE Workshop on Applied Health Economics and Policy Evaluation

The 5th IRDES-DAUPHINE Workshop on Applied Health Economics and Policy Evaluation, will take place in Paris, France, on 20-21 June 2019. The workshop is organized by IRDES, Institute for Research and Information in Health Economics, with the Chaire Santé Dauphine.

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French-English Glossary of Health Economics Terms

IRDES Book (5), Glossary Series. November 2018

This new online edition of the French-English Glossary of terms, concepts and acronyms in health economics has been reviewed and expanded by the IRDES Publications and Documentation teams. In addition to terms from specialized Anglo-Saxon journals, this edition is based on the English translations of IRDES thematic syntheses, Questions d'économie de la santé (Issues in Health Economics), and on the keywords of the MeSH thesaurus (Medline). It also includes a thematic section that classifies the translated terms according to the disciplines involved (economics, sociology, geography, etc.). The Glossary is updated regularly.

Care Pathways of Patients Hospitalised for Stroke: Initial Findings

Com-Ruelle L., Nestrigue C. (IRDES), in collaboration with Le Guen N., Bricard D., Le Neindre C., Lucas-Gabrielli V. (IRDES)
Issues in Health Economics (234). July-August 2018

A stroke involves the loss of one or more brain functions due to the sudden disruption of blood flow to the brain. It is the primary cause of death amongst women and the third cause amongst men, and results in a number of disabilities. The 2010-2014 French Stroke National Action Plan (Plan d'Actions National AVC) was set out specifically to improve the treatment of patients during the acute phase by facilitating their access to diagnostic imaging (MRI and CT scans) and the development of specialised hospital units -Stroke units (SU)-, and subsequently during the re-education and rehabilitation phase, to avoid death and an inability to recover from sequelae.
Thanks to the data matching from the French National Hospital Database (PMSI) with French National Health Insurance (NHI) data between 2010 and 2014, the characteristics of the adult victims of a stroke and their treatment have been observed more comprehensively than ever before. In 2012, of the 134,000 patients aged 18 or over who were hospitalised for a first episode of stroke, 99,000 had suffered from an established, full stroke, within the scope of this study. The patients were mainly admitted to hospital via the emergency department, and men and women were affected equally, except that men suffered strokes at an earlier age than women. Half of the victims of a stroke also suffered from one or several chronic diseases. Despite the development of diagnostic imaging techniques between 2010 and 2014, they appeared to be insufficient and only one patient in three was treated in a Stroke unit (SU). One out of seven died during the initial acute episode. A third of the survivors were subsequently admitted to a follow-up and rehabilitation care unit (FRC), an acknowledged way of limiting sequelae. Lastly, regional disparities in stroke incidence and variations in the various modalities of treatment remained marked.

The French Welfare System Minimises Out-of-Pocket Payments for People who Require Assistance

Penneau A., Pichetti S. et Espagnacq M. (IRDES)

Issues in Health Economics (233). May 2018

People who require human assistance to perform activities of daily living often have high healthcare expenses. This assistance is indeed often associated with pathologies that require intensive treatments and the purchase of costly medical equipment that may be complemented by high out-of-pocket payments after the reimbursement of National public health insurance. Yet, little is known about the social protection system's ability to limit this population's out-of-pocket payments.
Based on data from the Health and Disability Households survey (enquête Handicap Santé Ménages, HSM), the profiles of people aged 20 or over requiring assistance and living at home were analysed in terms of socio-demographic characteristics, health, healthcare costs, access to social protection schemes, and out-of-pocket payments. There are two distinct populations: people aged over and those under the age of 60, with different characteristics and different types of allowance.

Doctor-Nurse Cooperation Through ASALEE (Team Health Project in Private Practice): A Space Where Primary Care Practices are Being Transformed

Fournier C. (IRDES), Bourgeois I. (Icone Médiation Santé, IRDES), Naiditch M. (IRDES)

Issues in Health Economics (232). April 2018

The experimental project named "Team Health Project in Private Practice" (Action de SAnté Libérale En Équipe, ASALEE) was created in 2004 in order to improve primary care for patients with chronic diseases, through a better coordination between general practitioners (GPs) and nurses. Under this experiment, nurses are legally enabled to perform specific procedures or tasks, including the screening and care of chronic diseases, which are delegated to them by the GPs.
As part of the Doctor and Advanced Public Health Experiment Evaluation (DAPHNEE) Assessment programme, a sociological research based on a qualitative approach was carried out between 2015 and 2017. It explored, on the one hand, the implementation and organisation of the ASALEE project and it analysed, on the other hand, the practices and interactions between patients and health professionals.
Other aspects of this assessment program will be published by the Institute for Research and Information in Health Economics (Institut de Recherche et Documentation en Économie de la Santé, IRDES): a typology of the cooperation between doctors and nurses; the effects of the ASALEE project on doctors' activity and on patients' monitoring and care pathways.

Atlas of chronic end-stage renal disease in France

IN FRENCH

Le Neindre C., Bricard D., Sermet C. (IRDES), Bayer F., Couchoud C., Lassalle M. (ABM) Co-publishing IRDES-ABM

IRDES Book (4), Atlas series. October 2018

Chronic kidney disease affects approximately 5.7 million adults in France in 2015. Of these, 82 295 are treated for chronic end-stage renal disease, either by dialysis (56%) or transplant (44%). The mortality rate at this stage of the disease is high (10.6%) and the quality of life of people with the disease can also be affected. The stakes in terms of access to care and patient care, dimensions for which social and territorial disparities are reported, are therefore important. The economic stakes are also not negligible.
This atlas provides a photograph of chronic end-stage renal disease and its care coordination in France, as well as in the six territories targeted by the care pathways experiments of people with this disease. It brings together information that has so far been scattered on the demographic and socio-economic context, health status and care provision, as well as on the incidence and prevalence of the disease and the pathway of dialysis and transplant patients. To do this, the atlas is based on standardized indicators built at the level of a common observation unit, the department. The aim is to have a reference situation that will make it possible to measure developments, compare territories and better understand the problems specific to this pathology in order to improve access and quality of care.

Evaluation of impact of regional pilots Healthcare Pathways of seniors (Paerpa). First results + Appendix

IN FRENCH

Or Z., Bricard D., Le Guen N., Penneau A. (IRDES)

IRDES Report (567). June 2018

The regional pilots Paerpa (Healthcare Pathways of seniors) were launched in 2014 in nine territories, with the objective of improving care coordination and quality of life of elderly people aged 75 and over and their caregivers. The projects aim to improve collaboration between local actors involved in health and social care for improving the quality of overall care provision, preventing loss of autonomy and reducing hospital use.
The evaluation carried out by IRDES (Institute of Research and Information in Health Economics) aims to make an overall assessment of project results, taking into account specific characteristics of pilot territories, in the light of Paerpa’s objectives and using common criteria. This interim report presents the progress made in impact evaluation, shows main phases and methods of the evaluation, as well as the first results in 2015-2016.
Analysis of data from the first two years of Paerpa does not allow to establish a significant effect on any of the outcome indicators when all pilots evaluated together. However, we detect a significant improvement in some territories (pilots) on the outcomes the most sensitive to the primary care organization, such as polypharmacy and emergency visits.
These results crossed with the results from qualitative analyses and progress made in pilots in implementing different tools suggest that the difference in experience between territories can be a determining factor. It would be important to understand better the local projects and practices in territories where progress made is significant. However, lack of impact of pilots on hospital utilization, in all territories, suggest that it would be legitimate to explore other levers of action for improving hospital practices and coordination between hospital and primary care providers, and to evolve Paerpa.

Methodology of Impact Evaluation of the Regional Pilots "Healthcare Pathways of Seniors"

IN FRENCH

Bricard D., Or Z., Penneau A. (IRDES)

IRDES Working paper (74). June 2018

Regional pilots, healthcare pathways of seniors (Paerpa) launched in 2014 in nine territories (local areas) with the objective of improving care coordination and quality of life for frail elderly people (75 +) are an example of complex social experiment. They combine a series of national schemes implemented heterogeneously from one territory to another. The evaluation of complex experiments, such as Paerpa, represents methodological challenges because the treatment is heterogeneous and the impact of treatment can vary according to different territorial contexts.
In this article we present the synthetic control method as a means of assessing the impact of territorial policies and we test its robustness compared to more traditional alternatives. The evaluation is based mainly on data from the National Health Data System (SNDS) of 12 French regions from 2010 to 2016. Socio-economic contexts, health and social care provision of the territories are apprehended from numerous sources of data at municipal or departmental level.
Exploratory analyses highlight a selection bias for some territories and suggest that conventional regression methods may be inappropriate. The synthetic control method allows to vary the composition of the control groups by territory and by outcome indicator and to estimate the impact of Paerpa pilots in a robust manner. It provides a systematic means for identifying control units, gives the opportunity to explore in depth the results by territory and to be completely objective in the choice of control units. Complemented by qualitative analyzes, the method provides some useful keys for interpreting the results.

Migration-related Changes in Smoking among non-Western Immigrants in France

Khlat M., Legleye S., Bricard D. European Journal of Public Health, On line: 05/11/2018, 1-5.

Risk of Pressure Ulcers in Tetraplegic People: A French Survey Crossing Regional Experience with a Long-term Follow-up

Le Fort M., Espagnacq M., Albert T., Lefèvre C., Perrouin-Verbe B., Ravaud J.-F. European Journal of Public Health, en ligne : 2018/06/04

Impact of Diagnosis Related Group Refinement on the Choice between Scheduled Caesarean Section and Normal Delivery: Recent Evidence from France

Proshin A., Cazenave-Lacroutz A., Or Z., Rochaix L. PSE Working Papers n° 2018-25. 2018.

Accountable Care Organizations and Post-Acute Care: A Focus on Preferred SNF Networks

Kennedy G., Lewis V.A., Kundu S., Mousquès J., Colla C.H., Medical Care Research and Review, on line : 02/07/2018, 1-19.

Evaluating Health-care Equity

Raine R., Or Z., Prady S., Bevan G. In: Challenges, Solutions and Future Directions in the Evaluation of Service Innovations in Health Care and Public Health, Health Services and Delivery Research, vol 4, n° 16, 2016/05, 69-84.

A Multilevel Analysis of the Determinants of Emergency Care Visits by the Elderly in France

Or Z., Penneau A. Health Policy, Online: 18/05/2018.

Smoking Among Immigrant Groups in Metropolitan France: Prevalence Levels, Male-to-Female Ratios and Educational Gradients

Khlat M., Bricard D., Legleye S. BMC Public Health, vol 18: 479, 1-9, 2018/04.

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... IRDES Publishing and Documentation teams, on the occasion of the publication of a new, completed and enriched edition of the French-English Glossary of Health Economics Terms.

• How is this new edition of the glossary presented and how did it evolve?
• Who is it intended for? What are its main uses?
• What are the prospects for the evolution of the glossary?

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... Cécile Fournier, on the occasion of the publication of Issues in Health Economics (232), April 2018: "Doctor-Nurse Cooperation Through ASALEE (Team Health Project in Private Practice): A Space where Primary Care Practices are being transformed", written with Isabelle Bourgeois and Michel Naiditch.

• How did the ASALEE project of cooperation between patients, doctors and nurses develop?
• What are the main transformations of practices realised there?
• What extensions to this study are you considering?

Read the interview